Feasibility of Full Endoscopic Spine Surgery in Patients Over the Age of 70 Years With Degenerative Lumbar Spine Disease

Abstract

Objective: Degenerative spine disease, encompassing disc prolapse and stenosis, is a common ailment in old age. This prospective study was undertaken to evaluate the role of endoscopic spine surgery in elderly patients (above 70 years of age) with clinical and radiological follow-up.

Methods: In this study, a prospective analysis was conducted of 53 patients with lumbar disc prolapse or spinal stenosis who were treated with percutaneous endoscopic discectomy or decompression from November 2015 to June 2017. Clinical follow-up was done at 1 week, 3 months, and 1 year, and at yearly intervals thereafter. The outcomes were assessed using the modified Macnab criteria, a visual analogue scale, and the Oswestry Disability Index.

Results: Of the 53 patients, 21 were men and 32 were women. Their mean age was 76±4 years. The mean follow-up period was 17 months. Percutaneous endoscopic discectomy was performed in 24 patients and endoscopic decompression in 24 patients, while 5 patients underwent combined surgery. An excellent outcome in terms of the MacNab criteria was observed in 9 patients (16.98%), a good outcome in 38 patients (71.7%), and a poor outcome in 6 patients (11.3%). Of the 6 patients with a poor outcome, 5 (9.4%, 5 of 53) developed recurrent disc prolapse, and 1 developed hematoma with motor weakness. All 6 of these cases required revision surgery.

Conclusion: Managing degenerative spine disease in elderly patients with multiple comorbidities is a challenging task. Percutaneous endoscopic spine surgery is pivotal for addressing this concern. The authors have shown that optimal results can be achieved with various types of disc prolapse and stenosis with favorable long-term outcomes.

Keywords: Decompression; Disc prolapse; Discectomy; Old age; Stenosis; Percutaneous endoscopic spine surgery.

Fig. 1.

Graphs showing changes in visual analogue scale (VAS; A) and Oswestry Disability Index (ODI; B).

Fig. 2.

(A) Preoperative magnetic resonance imaging (MRI) of a case with severe lumbar canal stenosis with inferior migration of disc fragment at L3–4 level. (B) Postoperative MRI showing complete removal of inferiorly migrated herniated disc with bilateral decompression without violation of facet joints or muscle damage after percutaneous endoscopic stenosis lumbar decompression.

Fig. 3.

(A) Preoperative magnetic resonance imaging (MRI) of a case with severe lumbar canal stenosis at L4–5 level. (B) Postoperative MRI showing complete bilateral decompression without violation of facet joints or muscle damage after percutaneous endoscopic stenosis lumbar decompression.

Fig. 4.

(A) Preoperative magnetic resonance imaging (MRI) showing high-grade inferior migration of disc at L2–3 level. (B) Postoperative MRI showing complete removal of high grade inferiorly migrated herniated disc at L2–3 level. (C) Preoperative and postoperative computed tomography images of suprapedicular circumferential drilling to approach inferior migrated disc fragment.

Fig. 5.

(A) Preoperative magnetic resonance imaging (MRI) showing inferior migration of disc at L3–4 level and postoperative MRI showing complete removal of inferiorly migrated herniated disc at L3–4 level. (B) Recurrence after 2 years: Preoperative MRI showing inferior migration of disc at L3–4 level and postoperative MRI showing complete removal of inferiorly migrated herniated disc at L3–4 level.